Monthly Archives: March 2016

The Internet of Things will continue to grow at hospitals as data become easier to share

ILLUSTRATION BY ISTOCK

3.21.16 by Jeff Ferenc

It may be tempting to dismiss it as just another buzz phrase in a field bursting at the seams with jargon, but the Internet of Things (IoT) is here to stay in the health care facilities world. And it’s likely to continue to grow in popularity as hospitals leverage technologies in multiple ways to increase efficiency.

In basic terms, IoT gives things from cars to medical devices to building systems the ability to store and share valuable information through the use of data-capturing sensors and radio-frequency identification (RFID).

To varying degrees, many, if not most, hospitals have utilized the IoT for purposes from asset management to controlling temperature and humidity in operating rooms for a number of years. And health care technology and facility experts interviewed for this article expect that the IoT will only expand.

“IoT really is about connectivity, about trying to ensure if there’s a piece of information available to trigger an action, that the action can happen,” says Paul Currie, assistant vice president of enterprise architecture, HCA (Hospital Corporation of America), Nashville, Tenn.

“For instance, I’m thinking about situations in patient rooms where you want a specific temperature if the room is occupied and, if it’s not occupied, that temperature will change. That absolutely is the IoT,” he says.

Another example of how IoT can promote efficiency is a sensor collar for fire extinguishers that remotely detects the condition of a device and whether it needs to be replaced, Currie says. The shared data replace manual checks.

Brendon Buckley, health care technology director, North America, Johnson Controls, Milwaukee, says that the use of sensors leveraging data transmitted from machine to machine has existed for some time in uses such as building automation and environment optimization. “It just wasn’t called IoT,” he notes.

The phrase “Internet of Things” was coined in 1999 in response to a supply chain challenge that was solved through the use of a microchip and a radio receiver that tracked a popular cosmetic product’s inventory status.

Opened in 2015, the $50 million virtual care center delivers around-the-clock care through audio, video and data connections by clinical and support staff to remotely monitor patients in four states. Hood expects a growing number of health care systems to incorporate some of the benefits offered by the virtual care center.

“As patient monitoring expands to the home and use of wearable devices, clinicians’ monitoring of chronic conditions and incorporation of predictive analytics will increase demands on facility infrastructure and data center requirements,” he says.

The inability of proprietary medical devices to share data with each other will require development of a plug-and-play platform with a standard language. The Center for Medical Interoperability, Nashville, has undertaken that issue as its mission.

Security concerns likely will increase as the level of shared data rises with the growth of IoT. “The volume of data is going to grow substantially along with maintaining security to ensure there are no HIPAA violations or cyberattacks,” Hood says.

As challenges are met and managed, which sources say they are confident will occur in good time, the IoT will create the promise of improved health care.

“All these systems are going to have an incredible impact on care efficiency and without spending a lot of extra money,” according to Andrew Quirk, senior vice president, health care center of excellence, Skanska USA, Nashville. “We just need to be intelligent about how we integrate them.”

Despite objections by hospitals, the Federal Communications Commission is proceeding with an airwave auction next week that will force unlicensed wireless devices onto a channel previously reserved for patient monitors.

The FCC will sell licenses for much of the 600 MHz spectrum, allowing only unlicensed use on Channel 37, which has so far been blocked off exclusively for Wireless Medical Telemetry Systems, which allow vital-sign sensors to communicate with patient monitors and nurse station monitors. Allowing unlicensed devices onto the channel could cause interference with equipment that is critical to patient care, hospitals and advocates say.

Although the FCC has established 380-meter zones around hospitals where use of unlicensed devices will be prohibited, those zones are inadequate, said Erik Rasmussen, vice president of legislative affairs for the American Hospital Association. The AHA is calling for a standard buffer zone of at least three kilometers around hospitals. The FCC has said the zones can be extended at the request of a facility if needed.

“Hospitals need to continue using dedicated bands free of interference for patient monitoring,” Rasmussen said in a statement. “We are concerned that the protection zones for hospitals are not large enough, and once unlicensed devices begin operating nearby, patient safety may be endangered.”

While unlicensed devices still need to be certified by the FCC, new devices will likely have a more powerful signal than WMTS, which could make it easier for them to interfere with patient monitoring, said Mitchell Ross, a wireless health expert at the Center for Medical Interoperability. Staff at hospitals are relatively inexperienced in the telecommunications area, so they’ll have to flag problems to administrators who might then have to sue to stop interference, he said.

Electronics manufacturers have argued that freeing up the channel will allow for innovation in health gadgets and remote patient monitoring. But Ross said those kind of devices can use Wi-Fi or cellular networks – they don’t need to take space from WMTS.

“Patient care needs its own allocated frequencies,” Ross said. “600 MHz was a great stage for it to be until somebody said, hmm, I’d like to make money off that.”

Editor’s note: This is the first post from the Nashville Health Care Council’s 2016 Leadership Health Care Delegation to Washington. Look for more content in the coming days and click here for other entries from past years’ visits.

Leadership Health Care kicked off its two-day delegation to Washington, D.C., on Monday afternoon with a series of speakers focused on Medicaid policy, the interoperability of health care technology systems and — of course — the 2016 presidential race.

With the presidential primary season heating up, the delegation gathered in the W Hotel, adjacent to the White House grounds, and heard first from Politico Congressional Reporter Jake Sherman, who provided a look at what’s happening on the campaign trail and how members of Congress are responding to the seeming inevitability that Donald Trump will become the Republican Party’s nominee.

“This is probably one of the most surreal, unreal political moments we’ve ever been in,” Sherman said, giving the delegates a recent history of Republican politics to provide some rationale for the rise of Trump and providing an inside look into how Congressional Republicans are positioning themselves ahead of a Trump nomination.

“You’re going to see members of Congress all over the country distance themselves from Trump and (try to) save themselves from losing in what could be a very bad year for Republicans,” Sherman said.

Regardless of who is in the White House, TennCare Director Darin Gordon said he doesn’t see the tension between the federal government and state Medicaid programs changing any time soon. Gordon, who was interviewed by Matt Salo, executive director of the National Association of Medicaid Directors, said Tennessee and all states struggle to get the flexibility they need to be successful within the Centers for Medicare and Medicaid Services’ “homogeneous” approach to Medicaid policy.

With that need for flexibility in mind, Gordon talked about Tennessee’s failed attempt to earn legislative approval for the state’s own approach to expanding Medicaid under the Affordable Care Act.

“Part of what people don’t realize is we expanded (TennCare) in 1994, greater than anybody in the entire country ever has or probably ever will. It was greater than what the ACA contemplated by far,” he said. But the unsustainability of that expansion created an impossible uphill battle for Insure Tennessee, despite the program’s approval by CMS.

He said he thinks Tennessee will eventually join the 30 states that have already expanded Medicaid under the ACA, but “it’s going to be some time before we can get all the stars aligned.”

Later in the afternoon, a panel of experts discussed the state of interoperability of health care systems. Dr. Vindell Washington, principal deputy national coordinator of the Office of the National Coordinator for Health Information Technology, explained how the meaningful use program spurred the rapid adoption of electronic medical records over the past few years — to a point where 96 percent of all hospitals and three-quarters of physician practices have implemented EMRs.

But the industry has not yet figured out how to achieve true interoperability of information systems to support the overarching goal of delivering patient-centered care. Jitin Asnaai, executive director of CommonWell Health Alliance, said one of the several barriers to achieving interoperability is a cultural one — that during decades of moving toward greater and greater specialization, the health care industry hadn’t thought about how data flows between providers. And, perhaps worse, many physicians have come to assume that you just “won’t get the data.”

The nonprofit Center for Medical Interoperability is one of the organizations trying to chip away at this problem. Kerry McDermott, the organization’s vice president of public policy and communications, explained how health systems are working together through the Center to develop a “reference architecture” that is a blueprint for how medical devices should connect to share data. The organization — with board members including leaders from Community Health Systems, Vanderbilt, Ascension Health, LifePoint and HCA — is based in Nashville because the city has the “right culture in driving collaboration,” she said.

The pledge is designed to foster a marketplace of data analytics to encourage entrepreneurs to develop novel uses of health data that will improve patient safety and reduce preventable deaths. If enough medical technology companies share the data their products are purchased for, it allows engineers and researchers to develop predictive algorithms that notify clinicians and patients of dangerous trends. The pledge does not ask any company to share protected or proprietary data or not follow all the privacy laws. Companies can make their pledge online at http://patientsafetymovement.org/commitments/medical-technology-company-commitments/.

“From 9 companies in 2013 to now, 49 companies have made the pledge to share their data with whomever can use the data to create analytics and algorithms that may detect the ailment of the patient, and predict the patient’s health and direction of health to help caregivers prevent harm before it happens,” said Joe Kiani, Founder of the Patient Safety Movement Foundation. “We thank each and every one of these companies who are leading the way to safer patient care by giving their data. With data sharing, we will hopefully also unlock the mysteries behind cancer and heart disease and help identify therapies that are most likely to work. So what we’ve started here to treat the third leading cause of death – preventable patient harm, may one day even help the first and second causes of death.”

“I lost the love of my life to an information coordination error event that could have and should have been prevented,” said Brent Nibarger. “Had the data sharing pledge happened 5 years sooner, the types of algorithms the Patient Safety Movement speaks about likely would have saved my wife’s life. It’s important to remember that every preventable death statistic represents someone’s wife, husband, father, mother, brother, sister, or child and thus the resulting emotional, financial and family implications of these events reach far, far beyond what the reported numbers reflect. The caliber of companies that have stepped forward to join in this initiative to put patient safety first is incredible and it gives me hope for a safer patient care environment in the future.”

“The Patient Safety Movement was the first organization to connect the dots between data sharing and patient safety and then do something about it,” said Richard A. Packer, CEO of ZOLL. “We signed the pledge in 2013 with a handful of other companies. The movement has come a long way. We look forward to continuing to work closely with the Patient Safety Movement Foundation in eliminating preventable patient deaths.”

Ed Cantwell, Executive Director of the Center for Medical Interoperability, said, “We launched the Center shortly after the first press release from the Patient Safety Movement announcing nine companies had signed the pledge to share data. The Center as a provider-led centralized R&D lab, will drive plug and play interoperability from the point of care to and from enterprise systems. With 49 companies making the pledge and the launch of the Center, we know that we are very close to making patient care safe and effective systematically, in addition to our extraordinary caregivers. We will work with the Patient Safety Movement to make patient data help save patients’ lives by making the Patient Data Superhighway faster and fully interoperable.”

To date, the following 49 companies have made a pledge to share data:

Admetsys

LiDCO Group

AirStrip

Masimo

ATL Technology, LLC

Medical Intelligence

BrainStem Biometrics

Medical Simulation

Cercacor

Modulated Imaging

Cerner

Monarch Medical

Certa Dose

NeurOptics

Codonics

Oracle

CorCardia Group Inc.

Patient Valet

CRISI Medical Systems, Inc.

PerceptiMed

CrossChx

Philips Healthcare

Data Diagnostix

Predixion

DebMed

RGP Healthcare

Deltex

RightPatient

Dräger

S.E.A. Medical Systems, Inc.

Dynalabs

Securisyn Medical

EarlySense

Smiths Medical

ExCor Technologies, LLC

SonoSite Inc.

GE Healthcare

Sotera Wireless

Hyginex

SurgiCount Medical, Inc.

IBM Watson Health

True Process

ICUcare LLC

Welch Allyn

Innara Health

Zoex

Iradimed

ZOLL Medical

Kolkin Corp

About The Patient Safety Movement Foundation

More than 3,000,000 people worldwide, and 200,000 people in the US die every year in hospitals in ways that could have been prevented. The Patient Safety Movement Foundation was established through the support of the Masimo Foundation for Ethics, Innovation, and Competition in Healthcare, to reduce that number of preventable deaths to 0 by 2020 (0X2020) in the US and dramatically worldwide. Improving patient safety will require a collaborative effort from all stakeholders, including patients, healthcare providers, medical technology companies, government, employers, and private payers. The Patient Safety Movement Foundation works with all stakeholders to address the problems and solutions of patient safety. The Foundation also convenes the annual World Patient Safety, Science and Technology summit. The Summit presents specific, actionable solutions to meet patient safety challenges, encouraging medical technology companies to share the data for which their products are purchased, and asking hospitals to make commitments to implement Actionable Patient Safety Solutions. Visit www.patientsafetymovement.org.

“We are encouraged by the pledges to make health information easily and securely accessible. The public and private sectors must work together to advance this national priority, and we appreciate HHS’s leadership and commitment to our shared goals. The Center is engaging in its capacity as a cooperative R&D arm for health systems, guiding innovation and providing a vendor-neutral focal point to work with solution providers,” said Michael M. E. Johns, MD, founding chairman of the Center for Medical Interoperability and emeritus executive vice president for health affairs, president, CEO and chair, Emory Healthcare.

“The need for health information begins at the patient bedside. It’s a complex, challenging environment for nurses and we must create real-time records that are complete and consistent. This means breaking down proprietary silos at all levels of exchange and making it easier to share clinically rich data across medical devices and IT systems. The Center looks forward to collaborating on this,” said Michael Schatzlein, MD, vice chairman of the Center for Medical Interoperability and senior vice president and group ministry operating executive of Ascension Health.

The Center for Medical Interoperability is a 501(c)(3) organization led by health systems to change how medical technologies work together. We aim to improve real-time information flow and make technology function seamlessly in the background so we can achieve the best possible outcomes for patients. Our members are committed to compelling change and improving patient safety, care quality and outcomes, and reducing clinician burden and waste. Learn more at www.center4mi.org.

Health information technology developers that provide 90 percent of electronic health records used by U.S. hospitals and five largest healthcare systems agree to implement three commitments to improve the flow of health information

Today, U.S. Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced that companies that provide 90 percent of electronic health records used by U.S. hospitals, the nation’s five largest private healthcare systems, and more than a dozen leading professional associations and stakeholder groups have pledged to implement three core commitments that will improve the flow of health information to consumers and healthcare providers. Secretary Burwell made the announcement at the Health Information Management Systems Society conference attended by more than 40,000 health IT professionals, clinicians, executives, and vendors from around the world. The three commitments are:

Consumer Access:To help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community. Many of the biggest health IT developers have committed to using standardized application programming interfaces and a single shared standard for communicating with one another, Health Level 7 – Fast Health Care Interoperability Resources (FHIR®), so that user-friendly resources, like smartphone and tablet apps, can quickly be made market-ready and compatible with one another. These advances will make it easier for consumers to access their test results, track progress in their care, and communicate with their providers.

No Information Blocking:To help providers share individuals’ health information for care with other providers and their patients whenever permitted by law, and not block electronic health information (defined as knowingly and unreasonably interfering with information sharing). The report to Congress by the Office of the National Coordinator for Health IT (ONC) discussed the prevalence of information blocking.

Standards:Implement federally recognized, national interoperability standards, policies, guidance, and practices for electronic health information, and adopt best practices including those related to privacy and security. Many of these market leaders are embracing ONC’s Interoperability Standards Advisory—a coordinated catalog of existing and emerging standards and implementation specifications. This guidance is updated annually in order to keep pace with developments in the health IT industry. By identifying current best practices in standards, this advisory will assist healthcare providers to more easily collaborate with one another and share data across “interoperable” electronic health records.

“These commitments are a major step forward in our efforts to support a healthcare system that is better, smarter, and results in healthier people,” HHS Secretary Sylvia M. Burwell said. “Technology isn’t just one leg of our strategy to build a better healthcare system for our nation, it supports the entire effort. We are working to unlock healthcare data and information so that providers are better informed and patients and families can access their healthcare information, making them empowered, active participants in their own care.”

Currently, electronic health information flows only in pockets of the healthcare system and business practices can inhibit data sharing. Even when electronic health information is shared, it can be underutilized and difficult to access due to hard-to-use technology or the use of different standards. The commitments by health IT developers who provide electronic health records to the vast majority of the inpatient market, healthcare systems who serve patients in 46 states, and leading professional associations and stakeholder groups will help lead to a future where electronic health data is shared seamlessly and is easily accessible when and where it matters most to providers and consumers. To see a full list of individual organizations that have made commitments and their pledges, visit www.healthit.gov/commitment.

“The future of the nation’s health delivery system is one where electronic health information is unlocked and shared securely, yet seamlessly, to put patients at the center of their own care,” said Karen B. DeSalvo, M.D., M.P.H., M.Sc., national coordinator for health information technology. “The broad agreement by leaders in health and health IT across the nation brings us much closer to our vision for a truly learning, connected health system.”

The commitments announced today, together with the Federal Health IT Strategic Plan 2015-2020 and final Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, are designed to put the nation on a path to real, sustainable progress in the near-term to achieving better care for patients as a result of better information flow. As of 2014, nearly all hospitals and three-quarters of physicians use certified electronic health records. Today’s announcement is a major milestone in assuring those systems talk to one another—a critical foundation for precision medicine and a healthcare system where providers are paid for quality and collaboration.

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About the Center

The Center for Medical Interoperability is a 501(c)(3) cooperative research and development lab founded by health systems to simplify and advance data sharing among medical technologies and systems. We provide a centralized, vendor-neutral approach to performing technical work that enables person-centered care, testing and certifying devices and systems, and promoting the adoption of scalable solutions.

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